Outcomes after the regionalization of major surgical procedures in the Alberta Capital Health Region (Edmonton).

OBJECTIVE To evaluate the impact of regionalization on the outcomes of 16 surgical procedures performed in the Capital Health Region (Edmonton) of Alberta. DESIGN A computer search of hospital discharge abstracts coded for the Canadian Institute for Health Information. SETTING Two major hospitals in Edmonton. PATIENTS The study population comprised 9250 patients (9727 procedures [4524, pre-regionalization, 5203 post-regionalization]) who underwent any of 16 major procedures in the 2 years before and the 2 years after restructuring. OUTCOME MEASURES Demographic data, Charlson's comorbidity index, number of urgent and emergent cases, death rate, average length of hospital stay and the readmission rate. RESULTS The post-regionalization patient group was slightly older, had a higher comorbidity index, and fewer urgent and emergent cases. The case volume increased by 15%, and 43.6% of patients used some form of community-based health care services. The median length of hospital stay decreased from 8.0 days pre-regionalization to 7.0 days post-regionalization (p < 0.001). Overall and for specific procedures the death rate was unchanged (3.1% pre-regionalization, 2.4% post-regionalization, p = 0.06). The readmission rates were similar for both groups (8.0% versus 7.0%). CONCLUSIONS The consolidation of these 16 major surgical procedures had minimal impact on death and readmission rates even though patients in the post-regionalization group were slightly older and had greater comorbidity. There was a significant decline in the length of hospital stay, which occurred nationally over the same period, and a corresponding increase in the use of community-based services.